FUNCTIONAL TESTS - Myer, 2011 - Test COMBINE NFL Acl Reconstruction

[ research report ]
GREGORY D. MYER, PhD, FACSM, CSCS1 • LAURA C. SCHMITT, PT, MPT, PhD2 • JENSEN L. BRENT, CSCS3 • KEVIN R. FORD, PhD, FACSM4
KIM D. BARBER FOSS, MS, ATC, LAT5 • BRADLEY J. SCHERER, BS6 • ROBERT S. HEIDT JR., MD, FACS7
JON G. DIVINE, MD, FACSM8 • TIMOTHY E. HEWETT, PhD, FACSM9
Utilization of Modified NFL Combine

Testing to Identify Functional Deficits
in Athletes Following ACL Reconstruction
Downloaded from www.jospt.org at Otterbein University on July 1, 2014. For personal use only. No other uses without permission.
TTSTUDY DESIGN: Case control. of both lower extremities showed no group

TTOBJECTIVES: To use modified NFL Combine differences between the ACLR and control groups
testing methodology to test for functional deficits (P>.05). An overall group difference (P = .006) was
in athletes following anterior cruciate ligament observed for the combined limb symmetry index
(ACL) reconstruction following return to sport. (LSI) measures. However, the modified double-
I
limb performance tasks (long shuttle, modified
TTBACKGROUND: There is a need to develop
Copyright © 2011 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
agility T-test, and pro shuttle) were not, indepen- n the past 25 years, study of
objective, performance-based, on-field assess-
dently, sufficiently sensitive to detect limb deficits the anterior cruciate ligament
ment methods designed to identify potential lower
in individuals with ACL reconstruction. Conversely,
extremity performance deficits and related impair-
the LSI on the distance measures of the single- (ACL) has resulted in nearly
ments in this population.
limb performance tasks all provided moderate to 10 000 scientific articles
TTMETHODS: Eighteen patients (mean  SD age, large effect sizes to differentiate between the ACLR
16.9  2.1 years; height, 170.0  8.7 cm; body
indexed on Medline that focus
and control groups, as the individuals who had
mass, 71.9  21.8 kg) who returned to their sport ACL reconstruction demonstrated involved limb on the investigation of injury
within a year following ACL reconstruction (95% deficits on all measures (P<.05). Finally, the LSI incidence, mechanism of injury,
CI: 7.8 to 11.9 months from surgery) participated for the timed hop test was not different between
(ACLR group). These individuals were asked groups (P>.05). surgical repair techniques, and rehabili-
Journal of Orthopaedic & Sports Physical Therapy®
to bring 1 or 2 teammates to serve as control tation of this important knee-stabilizing

participants, who were matched for sex, sport, and TTCONCLUSIONS: These findings indicate that,
ligament. Due to the significant detri-
age (n = 20; mean  SD age, 16.9  1.1 years; while unilateral deficits are present in individu-
als following ACL reconstruction, they may not mental effects of ACL injury in young
height, 169.7  8.4 cm; body mass, 70.1  20.7
kg). Functional performance was tested using the be evident during bipedal performance or during athletes, such as loss of entire seasons of
broad jump, vertical jump, modified long shuttle, modified versions of double-limb performance sports participation and possible scholar-
modified pro shuttle, modified agility T-test, timed activities. Isolation of the involved limb with ship funding, significantly decreased aca-
hop, triple hop, single hop, and crossover hop unilateral hopping tasks should be used to identify demic performance,9 long-term disability,
tests. A 1-way multivariate analysis of variance deficits in performance. J Orthop Sports Phys
and up to 105 times greater risk of radio-
(MANOVA) was used to evaluate group differences Ther 2011;41(6):377-387, Epub 2 February 2011.
for dependent performance variables. doi:10.2519/jospt.2011.3547 graphically diagnosed osteoarthritis, 3
TTRESULTS: The functional performance measure- TTKEY WORDS: anterior cruciate ligament, hop
research efforts have focused on optimi-
ments of skills requiring bilateral involvement tests, knee, prevention zation of interventions to improve out-
comes following surgical reconstruction.
Co-Director of Research, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Instructor, Departments of Pediatrics and Orthopaedics,
1
University of Cincinnati, Cincinnati, OH; Post-Doctoral Fellow, Sports Medicine, Ohio State University, Columbus OH; Post-Doctoral Fellow, Departments of Physiology and Cell
Biology, The Ohio State University, Columbus, OH and University of Cincinnati, Cincinnati, OH. 2Adjunct Assistant Professor, Division of Sports Medicine, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH; Assistant Professor, Division of Physical Therapy, School of Allied Medical Professions, Ohio State University, Columbus, OH. 3Biomechanist, Division
of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. 4Co-Director of Research, Division of Sports Medicine, Cincinnati Children’s Hospital Medical
Center, Cincinnati, OH; Assistant Professor, Department of Pediatrics, University of Cincinnati, Cincinnati, OH. 5Athletic Trainer, Division of Sports Medicine, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH. 6Research Assistant, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH. 7Co-Director, Sports
Medicine and Arthroscopy Fellowship, Wellington Orthopaedic and Sports Medicine, Cincinnati, OH. 8Medical Director, Division of Sports Medicine, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH; Associate Professor, Department of Pediatrics, University of Cincinnati, Cincinnati, OH. 9Director of Research, Sports Medicine, Ohio State University,
Columbus OH; Professor, Departments of Physiology & Cell Biology, Family Medicine, Orthopaedic Surgery and Biomedical Engineering, The Ohio State University, Columbus, OH
and University of Cincinnati, Cincinnati, OH; Director, Sports Medicine Biodynamics center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Professor, Department
of Pediatrics, University of Cincinnati, Cincinnati, OH. This study was approved by the Cincinnati Children’s Hospital Institutional Review Board. Address correspondence to
Dr Gregory D. Myer, Sports Medicine Biodynamics Center, 2800 Winslow Ave, MLC 10001, Cincinnati, OH 45206. E-mail: greg.myer@cchmc.org
journal of orthopaedic & sports physical therapy | volume 41 | number 6 | june 2011 | 377
41-06 Myer.indd 377 5/18/2011 12:47:16 PM

[ research report ]
Reconstruction procedures con- such, the reintegration of athletes into
sistently restore joint stability to the unrestricted sports participation is often
previous level, and advances in graft characterized by participation in progres-
reconstruction and fixation techniques sively challenging on-field activities with
have led to the development of acceler- the team (eg, drills and technique train-
ated rehabilitation programs.46,47 These ing) under the guidance of the field clini-
rehabilitation protocols include progres- cian. These sport reintegration activities
sion through the acute, subacute, func- emphasize proper technique, as well as
tional, and return-to-activity51 phases of performance training, to prepare the
rehabilitation. Often, the focus is on the athlete for unrestricted sport participa-
management of the acute and subacute tion. However, the commonly used drills
phases, with relatively stringent guide- and performance-based training activi-
lines regarding progression of weight- ties, such as those performed in the NFL
bearing and range of motion (ROM), and Combine, are bilateral in their task de-
the selection of specific types of exercises. mands, and the performance of bilateral
These guidelines and supervised therapy drills and activities may mask deficits of
can significantly improve the early post- the involved lower extremity that persist
surgical outcomes.14 In contrast, guide- FIGURE 1. Broad jump test. into this phase of rehabilitation.
lines in the final phases of rehabilitation Following ACL reconstruction, defi-
are typically more general, with more cits in the involved lower extremity
global categorizations of appropriate persist long after individuals return to
exercises and progressions and the goal full activity. Several studies document
of transitioning the athlete following reduced functional scores, asymmetries
ACL reconstruction from the ability to in performance-based measures of func-
perform activities of daily living (ADL) tion, and deficits in quadriceps femoris
to proficiency with higher level sport- muscle strength after return to activity
related activities.16,45,50,51 For instance, and up to 18 to 24 months following re-
the typical ACL reconstruction protocols FIGURE 2. Standing vertical jump test and construction.2,18,19,39,41,52,53 Single-limb hop
lack objective guidelines to systematical- measurement. tests are often used to identify persistent
ly transition the athlete’s rehabilitation limb asymmetries in performance of
from activities focused on restoring tech- by pressure from coaches, parents, and higher level tasks, and deficits are quan-
niques in uniplanar planned movements teammates to accelerate the return-to- tified with a limb symmetry index (LSI)
to those that develop proficiency with sport timeline. During this phase of reha- [(involved side performance/uninvolved
multiplanar movements and ultimately bilitation, the treating clinician must be side performance) × 100%].6,44 Deficits
train mastery of dynamic neuromuscular especially cognizant of the potential gap in performance on single-leg hop tests
control requiring power generation and between the athlete’s perceived versus ac- and quadriceps muscle strength are of-
absorption.29 tual sports readiness, as subjective scores ten present in athletes following ACL
A significant goal of the final return- often do not correlate to quantified func- reconstruction when they are cleared for
to-sport phase of rehabilitation is to tion and strength scores in athletes with unrestricted sport participation.44 Im-
functionally progress and transition the ACL injuries and reconstructions.30,32,42 pairments and performance limitations
athlete towards proficient performance In the absence of objective measures that persist in the end stages of rehabili-
of higher level sport-related activi- that identify potential deficits,11 it may tation and beyond may be masked during
ties.16,45,50,51 The “release for full activity” be difficult for clinicians to justify con- on-field participation of predominantly
is a potentially sensitive landmark for tinued sport restriction and to identify bilateral, performance-based tasks. As
the athlete who has a strong desire to and address persistent functional defi- such, it is likely that athletes will partici-
return to immediate high-level sports cits related to the initial ACL injury or pate in the on-field sport reintegration
participation. Rehabilitation guidelines reconstruction. stage of rehabilitation with persisting
for appropriate transition and integra- The limiting of financial resources al- unilateral deficits.
tion into high-level activities are not well located to healthcare has increased the There is a need to develop objective,
documented. For the treating clinician role of on-the-field individuals in the pro- performance-based, on-field assessments
and recovering athlete, this phase of re- gression and transition of athletes’ return designed to identify potential lower ex-
habilitation is often further complicated to sport following ACL reconstruction. As tremity deficits in the late stage of reha-
378 | june 2011 | volume 41 | number 6 | journal of orthopaedic & sports physical therapy
41-06 Myer.indd 378 5/18/2011 12:47:18 PM

bilitation following ACL reconstruction. cinnati Children’s Hospital Medical Cen- was measured on a testing mat and re-
In an attempt to fill this need, we devel- ter. After informed consent was obtained, corded to the nearest centimeter (FIGURE
oped a series of tests based on the activi- height and weight were measured and re- 1). Athletes were instructed to start with
ties performed during the NFL Combine, corded. Participants were given a ques- the toes of both feet on a line and to use
which were modified to perform cutting tionnaire to report their prior history of arm swing to leap forward as far as pos-
and shuffling movements in a unilateral knee injury, which was corroborated by sible. Distance was measured from the
manner. Performance tests were taken a personal interview with the investiga- start line to where the closest body seg-
and modified from the NFL Combine, as tor.35 Concomitant injuries (eg, meniscal, ment touched on the test mat. Athletes
these activities are routinely used to as- other ligamentous, chondral) and specif- were allowed 2 trials to achieve maxi-
sess and train performance across many ics regarding surgical procedure (eg, graft mum broad jump distance to be recorded
different sports and athletic levels. type) were documented but were not fur- for analysis.
The purpose of this study was to de- ther analyzed in this study. Vertical Jump Vertical jump height was
termine if existing bilateral tests can be measured on an MX1 vertical jump train-
modified to expose unilateral lower limb Procedures er (MXP Sports, Reading, PA) (FIGURE 2).
deficits and to compare them to single- The current report provides an approach Prior to the test, each participant’s over-
leg hop tests presently used for this pur- to applying objective field-testing meth- head reach was determined by having the
pose. We hypothesized that the modified odology with functional tests designed participant reach directly overhead with
NFL Combine testing (modified double- to identify lower extremity asymmetry both hands up towards the ball, with the
limb performance testing) and single- and to demonstrating the potential use midline of the basketball aligned with the
limb performance testing (single-leg of these tests as reliable measures. These distal interphalangeal joint of the right
hop tests) would identify deficits in the data were collected in a large-scale 1-day and left middle fingers. The participant
involved limb of athletes following ACL field setting designed to replicate NFL was told to use a natural overhead reach
reconstruction who were cleared for Combine testing procedures, though (no exaggerated superior rotation of the
unrestricted return to sport. We further with some additional modifications. shoulder girdle). The digital readout of
hypothesized that athlete performance Athletes were randomly assigned to 1 the system was zeroed to subtract over-
on NFL Combine activities (double-limb of the 9 testing stations and proceeded head reach from jump height and thus
performance testing) would show perfor- through testing in a systematic man- to provide actual vertical displacement
mance equal to uninjured individuals. ner. At each testing station, the same during the vertical jump testing. Each
researcher instructed participants in participant stood 30.5 cm behind the

METHODS performing the appropriate test then midpoint of the MX1 ball attachment and
demonstrated its performance. If a task performed a countermovement vertical
Participants was not performed according to instruc- jump off both feet and grabbed the ball
E
ighteen individuals (mean  SD tions or data could not be recorded, the with both hands. The height of the MX1
age, 16.9  2.1 years; height, 170.0 participant immediately stopped and was adjusted to the maximum height
 8.7 cm; body mass, 71.9  21.8 rested. The participants in both groups from which the participant could grab the
kg) who had undergone a unilateral ACL were athletes involved in running and ball and maintain grip on the ball until
reconstruction (ACLR group) and re- cutting sports, with previous experience landing. The ball height was raised incre-
turned to their primary sport (football, performing activities similar to the de- mentally (2-5 cm), until the athlete could
soccer, basketball, or volleyball) within mands of the tasks used for testing. Ac- not pull the ball down from a height after
a year following reconstruction (95% CI: cordingly, proper test performance was 3 successive trials. The highest successful
7.8 to 11.9 months from surgery) were re- most often obtained after only 1 practice attempt was recorded. Prior authors have
cruited to participate. Participants in the trial by each participant. Limb testing demonstrated countermovement vertical
ACLR group were asked to bring 1 or 2 order was counterbalance randomized. jump testing to have a test-retest reliabil-
teammates with them to serve as control After each test station, participants ity of 0.993.48 We previously observed
group participants matched for activity were given a minimum of 2 minutes' rest that adding a goal provides a valuable
level, sex, sport, and age (n = 20; mean and were encouraged to wait until they extrinsic motivator to encourage maximal
 SD age, 16.9  1.1 years; height, 169.7 achieved full recovery before testing the effort during the task.8
 8.4 cm; body mass, 70.1  20.7 kg). opposite limb or transferring to the next
Informed written consent was obtained station. Modified Double-Limb Performance
from all participants (legal guardian if Testing
under 18 years of age) and approved by Double-Limb Performance Testing The T-test, pro shuttle, and long shuttle
The Institutional Review Board of Cin- Broad Jump The broad jump distance activities are used in field and NFL Com-
41-06 Myer.indd 379 5/18/2011 12:47:19 PM

[ research report ]
FIGURE 4. Modified pro shuttle.
The participants informed the investiga-

tors when they were ready to begin the
test, and timing gates were zeroed. Each
athlete initiated movement at a self-
selected time of readiness, and timing
began when any portion of the athlete’s
body bisected the timing gate. All trials
were electronically timed with SPARQ

XLR8 digital timing system (Nike Inc,
Beaverton, OR). After the participants
felt they had an adequate rest (at least 2
minutes), the contralateral direction was
tested. The total time was recorded for
each limb. One successful trial was per-
formed per limb, and the test run with
shuffle push-off limb (the involved limb
FIGURE 3. Modified agility T-test. driving push-off during the lateral shuf-
fle) was categorized as the involved trial.
bine settings to determine timed per- Modified Agility T-Test The modified We have previously demonstrated that
formance on tasks related to sports that agility T-test (FIGURE 3) was developed the modified T-test has good reliability
require quick starts, dynamic changes in from the standard T-test to evaluate in NFL Combine testing methods.13
direction, and efficient movement. How- lower extremity side-to-side differences Modified Pro Shuttle The pro shuttle was
ever, the standard performance of each in cutting and running maneuvers. The modified from the standard NFL Com-
of these tests combines left and right start limb for the modified agility T-test bine testing to force the athlete to com-
directional changes. While this is func- was counterbalance randomized. The plete the task in each direction instead
tionally ideal for individuals who require participant was initially guided through of self-selected preference only (FIGURE
cutting from both sides, it is not as use- the course by the test administrator, who 4). The participant was initially guided
ful for evaluation and comparison of po- emphasized the importance of perform- through the task by the test administra-
tential unilateral deficits. Therefore, the ing a shuffling movement and not run- tor, who emphasized the importance of
tests were modified to isolate cutting and ning or using crossover steps during the performing a shuffling movement and
shuffles in a unilateral manner.29 lateral movement portions of the test. not running or using crossover steps
41-06 Myer.indd 380 5/18/2011 12:47:21 PM

FIGURE 5. Modified long shuttle.
during the lateral movement portions of ing the opposite (180° from previous test) FIGURE 6. Hop tests.
the test. Each athlete was instructed to direction. The total time was recorded to
begin in a 3-point stance, with either the complete the task for each limb. One suc- back to start touch point, and finally to
right or left hand touching the ground cessful trial was performed per limb, and shuffle (without crossover steps) to the
directly in front of, and in line with, the the test run with initial shuffle push-off 45-ft (13.72 m) touch point and sprint
middle cone and the feet straddling the limb (the limb with ACL reconstruction back, breaking through the electronic
line. The participant was instructed to driving initial push-off ) was categorized timing gate. Athletes were required to
initiate the movement with a self-select- as the involved trial. The start limb for bend down and touch the line at each 15-,
ed starting point. Timing began when the modified pro shuttle was counterbal- 30- and 45-ft interval, for a total of 5 line
hand pressure was no longer sensed by ance assigned. touches. After the participants felt they
the timing pad. The athlete’s movement Modified Long Shuttle The long shuttle had an adequate rest (at least 2 minutes),
was initiated in the left-hand direction if was modified from the NFL Combine they performed the modified long shuttle
the left hand was touching the ground, long shuttle to isolate the push-off limb facing the opposite direction (180° from
or in the right-hand direction if the right during the activity (FIGURE 5). The start previous test). The total time was record-
hand was touching the ground. Once limb for the modified long shuttle was ed to complete the task for each limb. The
movement was initiated, the athlete was counterbalance assigned. The participant limb that was isolated during the shuffle
instructed to sprint to, and touch with was initially guided through the course push-offs was categorized as the testing
the outside hand, the cone 15 ft (4.57 m) by the test administrator, who empha- side during the trials. One successful trial
from the middle, then to reverse direc- sized the importance of performing a was performed per limb.
tion, run to the opposite cone 30 ft (9.14 shuffling movement and not running or
m) away, and touch that line with the using crossover steps during the lateral Single-Limb Performance Testing
outside hand. To finish, the athletes were movement portions of the test. From a Single Hop for Distance The athlete’s
instructed to reverse direction again and starting line, the participants were in- starting position for this maneuver was a
sprint through the electronic timing gate structed to shuffle (without crossover semi-crouched position on the single limb
(SPARQ XLR8 digital timing system) steps) 15 ft (4.57 m), to touch the line or being tested. The athlete was instructed
extending from the middle cone. After over the line with their fingers, to sprint to initiate the hop by swinging the arms
the participants felt that they had an back to the starting line touch point, then forward, simultaneously extending at the
adequate rest (at least 2 minutes), they to shuffle (without crossover steps) to the hip and knee, and hopping forward as far
performed the modified pro shuttle fac- 30-ft (9.14 m) touch point and sprint as possible while being able to land safely
41-06 Myer.indd 381 5/18/2011 12:47:23 PM

[ research report ]
on the same limb. A stabilized, 1-second
Mean Absolute Scores on the Tests
landing on the hop limb was required for TABLE 1
for Male Participants*
a successful trial (FIGURE 6A). Of the 2 tri-
als, that with the greatest distance was Test/Participant Group Control ACLR
used for further analysis. Testing was Vertical jump, cm 49.3 (15.3, 23.5) 49.9 (14.8, 24.5)
performed for both limbs, and the first Broad jump, cm 201.4 (66.4, 92.2) 213.0 (63.6, 104.2)
limb tested was determined with coun- Long shuttle, s†
terbalance randomization. Distance was Uninvolved/dominant† 8.7 (8.0, 9.3) 8.7 (7.0, 10.4)
measured to the nearest centimeter on a Involved/nondominant‡ 8.5 (7.6, 9.4) 8.7 (6.9, 10.5)
standard measuring tape affixed to the
MAT, s
floor. Uninvolved/dominant† 10.0 (8.7, 11.3) 10.3 (8.0, 12.6)
Crossover Hop for Distance The start- Involved/nondominant‡ 10.1 (8.5, 11.6) 10.4 (7.2, 13.6)
ing position for this maneuver was with Pro shuttle, s
the athlete in a semi-crouched position Uninvolved/dominant† 5.2 (5.0, 5.5) 5.3 (4.4, 6.3)
on the single limb being tested. The ath- Involved/nondominant‡ 5.3 (5.2, 5.4) 5.2 (4.0, 6.5)
lete was instructed to initiate the hop by Single hop, cm
swinging the arms forward and hopping Uninvolved/dominant† 194.3 (158.0, 230.5) 197.3 (142.0, 252.5)
forward as far as the athlete could and Involved/nondominant‡ 199.2 (166.8, 231.7) 184.9 (108.4, 261.4)
land safely on the same foot but on the Triple hop, cm
opposite side of the line medial to the Uninvolved/dominant† 539.0 (387.4, 690.5) 541.8 (300.3, 783.2)
stance limb. Athletes were instructed to Involved/nondominant‡ 546.8 (422.1, 671.5) 513.3 (230.9, 795.6)
immediately redirect into 2 subsequent Crossover hop, cm
forward-directed hops, crossing over the Uninvolved/dominant† 504.4 (360.2, 648.6) 499.0 (245.0, 753.0)
midline with each hop. The final landing Involved/nondominant‡ 496.8 (377.2, 616.4) 468.5 (177.6, 759.4)
on the hop limb was required to be stabi- Timed hop, s
lized and held for 1 second to be recorded Uninvolved/dominant† 2.5 (2.0, 3.0) 2.4 (1.7, 3.0)
as a successful trial (FIGURE 6B). The trial Involved/nondominant‡ 2.4 (2.0, 2.9) 2.6 (1.1, 4.1)
with the greatest distance out of 2 tri- Abbreviations: ACLR, individuals following unilateral anterior cruciate ligament reconstruction;
als was used for further analysis. Both MAT, modified agility T-test.
limbs were tested, with the first limb to *Values are mean (95% confidence interval).
†
Uninvolved side for those in the ACLR group and dominant side for those in the control group.
be tested determined by counterbalance ‡
Involved side for those in the ACLR group and nondominant side for those in the control group.
randomization. Distance was measured
to the nearest centimeter on a standard
measuring tape affixed to the floor. centimeter on a standard measuring tape first was determined with counterbalance
Triple Hop for Distance The starting affixed to the floor. randomization.
position for this maneuver was a semi- Six-Meter Timed Hop The starting po-
crouched position on the single limb sition for this maneuver was with the Statistics
being tested. The athlete was instructed athlete in a semi-crouched position on Two separate 1-way multivariate analyses
to initiate the hop by swinging the arms the single limb being tested. The athlete of variance were employed to investigate
forward, while hopping forward as far as began with the toe on the start transmit- the group differences (ACLR versus con-
possible and safely landing on the same ter. Timing began when toe pressure was trol) for the double-limb performance
limb, and to immediately redirect into 2 removed and ended when the athlete measures and LSI measures for the
subsequent hops, holding the third land- interrupted the infrared beam at the modified double-limb and single-limb
ing. The final landing on the hop limb distance of 6 m from the starting line. performance tests. LSI for the distance
had to be stabilized and held for 1 second The athlete was instructed to hop on the performance measurements was cal-
to be recorded as a successful trial (FIGURE single limb as fast as possible to reach the culated as the ratio of the value for the
6C). The trial with the greatest distance finish line. The fastest time of 2 success- involved side, divided by the value for
out of 2 trials was used for further analy- ful trials measured using the Speed Trap the uninvolved side, multiplied by 100;
sis. Testing was performed for both limbs, II timing system (Brower Timing Sys- LSI for the timed performance measure-
and the limb tested first was determined tems, Draper, UT) (FIGURE 6D) was used ments was calculated as the ratio of the
with counterbalance randomization. The for data analysis. Testing was performed value for the uninvolved side, divided
distance was measured to the nearest for both limbs, and the limb to be tested by the value for the involved side, mul-
41-06 Myer.indd 382 5/18/2011 12:47:24 PM

A separate 1-way multivariate analysis
Mean Absolute Scores on the Tests
TABLE 2 of variance was employed to investigate
for Female Participants*
the group (ACLR versus control) differ-
Test Control ACLR
ences in LSI measures for the 7 tests cat-
Vertical jump, cm 38.6 (14.3, 16.2) 35.9 (12.1, 16.1)
egorized as either modified double-limb
Broad jump, cm 159.1 (58.2, 67.1) 160.7 (58.3, 68.2)
performance tasks or single-limb per-
Long shuttle, s
formance tasks. There was a statistically
Uninvolved/dominant† 9.1 (8.6, 9.6) 9.4 (8.9, 9.8)
significant main effect for group for the
Involved/nondominant‡ 9.1 (8.7, 9.5) 9.3 (8.9, 9.7)
combined dependent variables (P = .006),
with a large effect size observed (partial
MAT, s
eta-squared, 0.458). Upon evaluation of
the results for each of the LSI measures,
Pro shuttle, s
a distinct group difference was noted for
the single-limb performance tests, while
the modified double-limb performance
Single hop, cm
tasks were not sufficiently sensitive to de-
tect limb deficits in individuals after ACL
reconstruction. Specifically, the LSI for
Triple hop, cm
the long shuttle, modified agility T-test,

and pro shuttle were not different be-
tween ACLR and control groups (P>.05),
Crossover hop, cm
with very small effect sizes to differenti-
ate between groups (partial eta-squared
values lower than 0.05).
Timed hop, s
The LSI for single-limb tests indicated
significant deficits in the ACLR group.
The LSI for the single hop test was 92%
in the ACLR group, compared to 100% in
Abbreviations: ACLR, individuals following unilateral anterior cruciate ligament reconstruction;
MAT, modified agility T-test. the control (P<.001) group, with a large
*Values are mean (95% confidence interval). effect size (partial eta-squared, 0.36).
†
Uninvolved side for those in the ACLR group and dominant side for those in the control group.
The triple hop LSI was significantly lower
‡
Involved side for those in the ACLR group and nondominant side for those in the control group.
(P<.001) in the ACLR group (91%) com-
pared to the control group (100%), with
tiplied by 100. LSI values are, therefore, RESULTS a large effect size (partial eta-squared,
expressed in percentages, with a score 0.31). Similar results were found for the
T
lower than 100% indicating a deficit (less he participants in the ACLR crossover hop LSI (ACLR, 92%; control,
distance covered or more time used) of group were not different from those 97%; P = .03), with a moderate effect
the involved side. The dominant limb in the control group for age, height, size (partial eta-squared, 0.13). Finally,
was determined by asking the partici- and mass (P>.05). TABLES 1 and 2 present the LSI for the timed hop test was not
pants which leg they would use to “kick a the absolute performance scores, split different between groups (ACLR, 96%;
ball as far as possible.” The involved limb by group for the male and female par- control, 100%; P>.05), with a small to
of individuals in the ACLR group was ticipants. The double-limb performance moderate effect to determine group dif-
matched to the nondominant limb of in- tests showed no group differences be- ferences (partial eta-squared, 0.06).
dividuals in the control group. Prelimi- tween ACLR and control groups (P>.05).
nary assumption testing was performed The ACLR group demonstrated a mean DISCUSSION
to check for univariate and multivariate  SD countermovement vertical jump
A
outliers, normality, and multicollinearity, maximum height of 40.1  11.3 cm, symmetries in limb perfor-
with no serious violations noted. Statis- compared to 41.3  7.2 cm for the con- mance during athletic tasks may be
tical analyses were conducted in SPSS trol group (P>.05). The broad jump dis- potential risk factors for lower ex-
Version 18.0 (SPSS Inc, Chicago, IL). tance was also similar between the ACLR tremity injury, particularly second ACL
Statistical significance was established a (176.3  34.0 cm) and control (169.7  injury, and should be minimized prior
priori at P<.05. 28.3 cm) groups (P>.05). to return to sport following ACL recon-
41-06 Myer.indd 383 5/18/2011 12:47:25 PM

[ research report ]
of the test. For this reason, we modified
Mean Limb Symmetry Index Scores
TABLE 3 these agility measures to increase reli-
on the Tests for All Participants*
ance on a single limb during the task.
Test Control ACLR
We hypothesized that this modification
Long shuttle 101 (98, 103) 101 (99, 103)
would identify the differences between
MAT 101 (98, 103) 100 (97, 102)
an athlete’s involved and noninvolved
Pro shuttle 102 (99, 105) 99 (96, 103)
sides better than the standard tests used
Single leg hop 100 (98, 103) 92 (89, 95)
to assess sports-related agility. Despite
Triple hop 100 (97, 103) 91 (88, 94)
the modifications, we did not find asym-
metries during these tasks. It may be that
Crossover hop 97 (94, 101) 92 (89, 95)

Timed hop 100 (96, 104) 96 (91, 100)
despite the modifications, the repeated
bilateral nature of the tasks may allow
Abbreviations: ACLR, individuals following unilateral anterior cruciate ligament reconstruction;
MAT, modified agility T-test. the uninvolved limb to mask deficits of
*Values are mean (95% confidence interval). the involved lower extremity that were
evident from the single-limb task test-
struction.38 All stages of rehabilitation flexibility, and coordination, all of which ing. These data indicate that these types
following ACL reconstruction should may be important predictors of increased of modifications to bilateral agility tasks
attempt to identify and minimize these injury risk.1,12,15 Knapik et al13 demonstrat- may not be adequate to identify involved
limb asymmetries, not only with strength ed that side-to-side balance in strength limb deficits of the magnitude seen in this
but with performance of athletic ma- and flexibility is important for the pre- group of athletes.
neuvers. Side-to-side asymmetries are vention of injuries, and that athletes are Isolated single-limb performance
evident during drop landing4 and drop more injury prone when asymmetries are tasks, such as the single-leg hop tests
vertical jump34 in patients following ACL present. Baumhauer et al1 also found that used in this study, may provide a criti-
reconstruction for up to 2 years. Athletes individuals with muscle strength imbal- cal component to field-based functional
who demonstrate side-to-side differenc- ances exhibited higher incidence of in- performance testing to identify persis-
es in biomechanical measures during a jury. Paterno and colleagues33 reported tent deficits in lower limb performance,
drop vertical jump are at increased risk that, after an athlete is released to return including deficits in functional power,
of ACL injury, when compared to those to sport post ACL reconstruction, altered force attenuation, and postural stability.
with more symmetrical lower extremity neuromuscular control of the hip and Specifically, single-leg hop tests, such as
biomechanics.12 A 5-year follow-up for a side-to-side asymmetry in knee joint re- the single hop for distance, triple hop for
cohort with asymmetrical limb-to-limb cruitment during a dynamic landing task distance, and crossover hop for distance,
biomechanics related to their initial in- are predictors of a second ACL injury.37 demonstrated potentially significant
jury also demonstrated a very high rate Side-to-side asymmetries may increase functional deficits in athletes released
of secondary injury (44%).12 injury risk for both limbs. Overreliance to full sport reintegration. The ability to
Following ACL reconstruction, pa- on the uninvolved limb can put greater generate and maintain isolated single-
tients frequently demonstrate asym- stress and torques on that knee, while limb power is important during single-
metrical force distribution in the lower the involved limb may be at risk due to limb cutting maneuvers in sport. Also,
extremities when performing high-level an inability of the musculature to effec- improved ability to attenuate force on
tasks such as landing5 and less dynamic tively absorb the high forces associated a single limb and the regeneration and
tasks such as squatting.31 Neitzel et al27 with sporting activities. Considering the redirection of motion may be relevant to
demonstrated that, during squatting, in- potential for side-to-side biomechanical reducing in injury risk in various single-
dividuals with ACL reconstruction were differences to increase risk for subse- limb actions in sports.17,22,32 Specifically,
unable to balance side-to-side loading quent ACL injury, identification of limb athletes who use a landing strategy char-
equal to that of controls until 12 to 15 asymmetries and appropriate interven- acterized by decreased knee flexion may
months following surgery. The individu- tion are necessary prior to reintegration increase out-of-plane loads, increase
als with ACL reconstruction demonstrat- into sport competition. ground reaction forces, and subject their
ed side-to-side deficits between 33% and While the standard T-test, pro shuttle, limb to abrupt bone-to-bone stress at the
48% at 1.5 to 4 months postsurgery and and long shuttle are basic criteria for the knee.20,25 This may be evident in increased
deficits between 21% and 28% at 6 to 7 assessment of sports-related agility,10,38,49 landing forces and could be a result of de-
months postsurgery. Asymmetrical limb they may not adequately measure side- creased thigh muscle strength.17 If tasks
loading is likely influenced by side-to- to-side differences, due to the equaliza- that isolate single-limb performance are
side imbalances in muscular strength, tion of cutting directions in performance sensitive to involved limb deficits, then
41-06 Myer.indd 384 5/18/2011 12:47:27 PM

these athletes may be targeted with neu- also evaluate quality of movement may R01-AR049735, R01-AR05563, and R01-
romuscular training that increases hip be beneficial to include in assessment of AR056259. The authors acknowledge the
and thigh muscle strength,21,26 improves athletes who wish to return to sport and Sports Medicine Biodynamics Team, espe-
postural stability,35 and increases single- should be further investigated to validate cially Dr Mark Paterno, who worked together
limb force generation and attenuation.22,26 their utility for use in criterion-based to make large data collection session possible.
In addition, neuromuscular training can return-to-sport guidelines.7,24,25,29,40 The authors would like to thank St Xavier
also reduce side-to-side deficits in single- High School, including Wellington Orthopae-
limb force attenuation,22 which may pro- CONCLUSION dics (Richelle Gwin, John Brehm, and Michael
vide the ultimate benefit to athletes who Gordon), for their invaluable support to com-
S
have had ACL reconstruction and desire ingle-limb tasks identified sig- plete this project.
return to sport.27 nificant residual deficits in indi-

Following ACL reconstruction, the viduals who had been allowed full
athletes who participated in this study unrestricted return to sport following REFERENCES
demonstrated greater limb asymmetry ACL reconstruction. Modification of bi-
1. B aumhauer JF, Alosa DM, Renstrom AF, Tre-
on the performance of single-limb tasks lateral limb tasks with tests focused to vino S, Beynnon B. A prospective study of
compared to control participants. These isolate single-limb performance did not ankle injury risk factors. Am J Sports Med.
findings are similar to those of our pre- provide enough sensitivity to identify 1995;23:564-570.
vious research in athletes following ACL these deficits. The development of sensi- 2. Bush-Joseph CA, Hurwitz DE, Patel RR, et al. Dy-
namic function after anterior cruciate ligament
reconstruction at the time of return to tive test protocols that can be incorporat- reconstruction with autologous patellar tendon.
sport. We identified significant limb ed into bilateral, field-based movement Am J Sports Med. 2001;29:36-41.
asymmetries in performance during sin- patterns should be further investigated. t 3. Deacon A, Bennell K, Kiss ZS, Crossley K,
gle-limb hop tests and in knee joint me- Brukner P. Osteoarthritis of the knee in retired,
elite Australian Rules footballers. Med J Aust.
chanics during a bilateral landing-jump KEY POINTS 1997;166:187-190.
task.43,44 Munro and colleagues reported FINDINGS: Single-limb tasks identified sig- 4. Decker MJ, Torry MR, Noonan TJ, Riviere A,
that the current hop tests provided re- nificant residual deficits in individuals Sterett WI. Landing adaptations after ACL recon-
liable scores for use with subjects in a allowed full unrestricted return to sport struction. Med Sci Sports Exerc. 2002;34:1408-
1413. http://dx.doi.org/10.1249/01.
clinical or team sport environment. In following ACL reconstruction. Modifica-
MSS.0000027627.82650.1F
addition, based on their normal subjects’ tion of bilateral limb tasks with tests fo- 5. Decker MJ, Torry MR, Noonan TJ, Sterett WI,
scores of greater than 90% LSI on all 4 cused to isolate single-limb performance Steadman JR. Gait retraining after anterior cru-
hop tests, they recommend that a mini- did not provide sufficient sensitivity to ciate ligament reconstruction. Arch Phys Med
Rehabil. 2004;85:848-856.
mum limb symmetry value of greater identify these deficits.
6. Eitzen I, Moksnes H, Snyder-Mackler L, Risberg
than 90% be utilized during rehabilita- IMPLICATIONS: The unilateral functional MA. A progressive 5-week exercise therapy pro-
tion and conditioning rather than previ- deficits identified in patients follow- gram leads to significant improvement in knee
ously recommended 85%.21 The current ing ACL reconstruction in the current function early after anterior cruciate ligament
injury. J Orthop Sports Phys Ther. 2010;40:705-
results support the possibility that the study may place them at greater risk of
721. http://dx.doi.org/10.2519/jospt.2010.3345
85% LSI criterion may not be sufficiently reinjury. 7. Ekegren CL, Miller WC, Celebrini RG, Eng
sensitive to capture residual deficits in CAUTION: There may be other combina- JJ, Macintyre DL. Reliability and validity of
athletes following ACLR. tions of single- and double-limb tasks observational risk screening in evaluating dy-
Residual biomechanical and neuro- that will help to further quantify func- namic knee valgus. J Orthop Sports Phys Ther.
2009;39:665-674. http://dx.doi.org/10.2519/
muscular deficits may increase reinjury tional deficits following ACL recon- jospt.2009.3004
risk during early sports reintegration. struction. These measurements may 8. Ford KR, Myer GD, Smith RL, Byrnes RN, Dopirak
However, we do not know the criterion not measure the quality of movement SE, Hewett TE. Use of an overhead goal alters
performance values that would lead to (eg, lower limb alignment) during these vertical jump performance and biomechanics.
J Strength Cond Res. 2005;19:394-399. http://
increased risk of injury following ACL challenging tasks, which may also be
dx.doi.org/10.1519/15834.1
reconstruction. Although limb asymme- predictive determinants of second injury 9. Freedman KB, Glasgow MT, Glasgow SG, Ber-
tries were identified, 1 of the limitations following ACL reconstruction. nstein J. Anterior cruciate ligament injury and
of these types of tasks (single hop, triple reconstruction among university students. Clin
Orthop Relat Res. 1998;208-212.
hop, etc) is the inability to account for ACKNOWLEDGEMENTS: The authors would
10. Grobler LA, Schwellnus MP, Trichard C, Calder S,
overall quality of movement (dynamic like to acknowledge funding support from Noakes TD, Derman WE. Comparative effects of
valgus, decreased knee flexion, altered NFL Charities. The authors would also like zopiclone and loprazolam on psychomotor and
trunk mechanics, etc) while performing to acknowledge funding support from Na- physical performance in active individuals. Clin
J Sport Med. 2000;10:123-128.
these tasks. Clinic-based assessments that tional Institutes of Health/NIAMS grants
41-06 Myer.indd 385 5/18/2011 12:47:28 PM

[ research report ]
11. H artigan EH, Axe MJ, Snyder-Mackler L. Time and balance training on power, balance, and Phys Ther. 2004;34:305-316.
line for noncopers to pass return-to-sports landing force in female athletes. J Strength 37. P aterno MV, Schmitt LC, Ford KR, et al. Bio-
criteria after anterior cruciate ligament re- Cond Res. 2006;20:345-353. http://dx.doi. mechanical measures during landing and
construction. J Orthop Sports Phys Ther. org/10.1519/R-17955.1 postural stability predict second anterior
2010;40:141-154. http://dx.doi.org/10.2519/ 24. Myer GD, Ford KR, Hewett TE. Rationale and cruciate ligament injury after anterior cruciate
jospt.2010.3168 clinical techniques for anterior cruciate ligament ligament reconstruction and return to sport.
12. Hewett TE, Myer GD, Ford KR, et al. Bio- injury prevention among female athletes. J Athl Am J Sports Med. 38:1968-1978. http://dx.doi.
mechanical measures of neuromuscular Train. 2004;39:352-364. org/10.1177/0363546510376053
control and valgus loading of the knee pre- 25. Myer GD, Ford KR, Hewett TE. Tuck jump assess- 38. Pauole KK. The Physical Performance T-Test
dict anterior cruciate ligament injury risk in ment for reducing anterior cruciate ligament as a Measure of Speed, Power, and Agility in
female athletes: a prospective study. Am J injury risk. Athl Ther Today. 2008;13:39-44. Females. Long Beach, CA: California State Uni-
Sports Med. 2005;33:492-501. http://dx.doi. 26. Myer GD, Ford KR, Khoury J, Succop P, Hewett versity; 1996.
org/10.1177/0363546504269591 TE. Biomechanics laboratory-based prediction 39. Petschnig R, Baron R, Albrecht M. The relation-
13. Hickey KC, Quatman CE, Myer GD, Ford algorithm to identify female athletes with high ship between isokinetic quadriceps strength
KR, Brosky JA, Hewett TE. Methodological knee loads that increase risk of ACL injury. test and hop tests for distance and one-legged
report: dynamic field tests used in an NFL Br J Sports Med. 45:245-252. http://dx.doi. vertical jump test following anterior cruciate
combine setting to identify lower-extremity org/10.1136/bjsm.2009.069351 ligament reconstruction. J Orthop Sports Phys
functional asymmetries. J Strength Cond Res. 27. Myer GD, Ford KR, Palumbo JP, Hewett TE. Ther. 1998;28:23-31.
2009;23:2500-2506. http://dx.doi.org/10.1519/ Neuromuscular training improves performance 40. Powers CM. The influence of abnormal hip
JSC.0b013e3181b1f77b and lower-extremity biomechanics in female mechanics on knee injury: a biomechani-
14. Howe JG, Johnson RJ, Kaplan MJ, Fleming B, athletes. J Strength Cond Res. 2005;19:51-60. cal perspective. J Orthop Sports Phys Ther.
Jarvinen M. Anterior cruciate ligament recon- http://dx.doi.org/10.1519/13643.1 2010;40:42-51. http://dx.doi.org/10.2519/
struction using quadriceps patellar tendon graft. 28. Myer GD, Paterno MV, Ford KR, Hewett TE. Neu- jospt.2010.3337
Part I. Long-term followup. Am J Sports Med. romuscular training techniques to target deficits 41. Risberg MA, Holm I, Tjomsland O, Ljunggren E,
1991;19:447-457. before return to sport after anterior cruciate Ekeland A. Prospective study of changes in im-
15. Knapik JJ, Bauman CL, Jones BH, Harris JM, ligament reconstruction. J Strength Cond Res. pairments and disabilities after anterior cruciate
Vaughan L. Preseason strength and flexibility 2008;22:987-1014. http://dx.doi.org/10.1519/ ligament reconstruction. J Orthop Sports Phys
imbalances associated with athletic injuries in JSC.0b013e31816a86cd Ther. 1999;29:400-412.
female collegiate athletes. Am J Sports Med. 29. Myer GD, Paterno MV, Ford KR, Quatman CE, 42. Ross MD, Irrgang JJ, Denegar CR, McCloy CM,
1991;19:76-81. Hewett TE. Rehabilitation after anterior cruciate Unangst ET. The relationship between participa-
16. Kvist J. Rehabilitation following anterior cruci- ligament reconstruction: criteria-based progres- tion restrictions and selected clinical measures
ate ligament injury: current recommenda- sion through the return-to-sport phase. J Orthop following anterior cruciate ligament reconstruc-
tions for sports participation. Sports Med. Sports Phys Ther. 2006;36:385-402. http:// tion. Knee Surg Sports Traumatol Arthrosc.
2004;34:269-280. dx.doi.org/10.2519/jospt.2006.2222 2002;10:10-19. http://dx.doi.org/10.1007/
17. Lephart SM, Ferris CM, Riemann BL, Myers JB, 30. Neeb TB, Aufdemkampe G, Wagener JH, s001670100238
Fu FH. Gender differences in strength and lower Mastenbroek L. Assessing anterior cruciate 43. Schmitt LC, Paterno MV, Ford KR, Myer GD,
extremity kinematics during landing. Clin Orthop ligament injuries: the association and differen- Hewett TE. Altered knee mechanics during lad-
Relat Res. 2002;162-169. tial value of questionnaires, clinical tests, and ning at the time of return to sport following ACL
18. Mattacola CG, Perrin DH, Gansneder BM, functional tests. J Orthop Sports Phys Ther. reconstruction: effects of quadriceps strength
Gieck JH, Saliba EN, McCue FC, 3rd. Strength, 1997;26:324-331. asymmetry [abstract]. J Orthop Sports Phys
functional outcome, and postural stability after 31. Neitzel JA, Kernozek TW, Davies GJ. Loading Ther. 2010;2010:A42.
anterior cruciate ligament reconstruction. J Athl response following anterior cruciate ligament re- 44. Schmitt LC, Paterno MV, Hewett TE. Functional
Train. 2002;37:262-268. construction during the parallel squat exercise. performance at the time of return to sport fol-
19. McHugh MP, Tyler TF, Browne MG, Gleim GW, Clin Biomech (Bristol, Avon). 2002;17:551-554. lowing ACL reconstruction: the impact of quad-
Nicholas SJ. Electromyographic predictors of 32. Noyes FR, McGinniss GH. Controversy about riceps strength asymmetry [abstract]. J Orthop
residual quadriceps muscle weakness after treatment of the knee with anterior cruciate lax- Sports Phys Ther. 2009;39:A103.
anterior cruciate ligament reconstruction. Am J ity. Clin Orthop Relat Res. 1985;61-76. 45. Shelbourne KD, Nitz P. Accelerated rehabilitation
Sports Med. 2002;30:334-339. 33. Olsen OE, Myklebust G, Engebretsen L, Bahr after anterior cruciate ligament reconstruction.
20. Meyer EG, Villwock MR, Haut RC. Osteochon- R. Injury mechanisms for anterior cruciate Am J Sports Med. 1990;18:292-299.
dral microdamage from valgus bending of the ligament injuries in team handball: a sys- 46. Shelbourne KD, Nitz P. Accelerated rehabilitation
human knee. Clin Biomech (Bristol, Avon). tematic video analysis. Am J Sports Med. after anterior cruciate ligament reconstruction.
2009;24:577-582. http://dx.doi.org/10.1016/j. 2004;32:1002-1012. J Orthop Sports Phys Ther. 1992;15:256-264.
clinbiomech.2009.05.006 34. Paterno MV, Ford KR, Myer GD, Heyl R, Hewett 47. Shen C, Jiang SD, Jiang LS, Dai LY. Bioabsorb-
21. Munro AG, Herrington LC. Between-session reli- TE. Biomechanical limb asymmetries in female able versus metallic interference screw fixation
ability of four hop tests and the agility T-test. J athletes 2 years following ACL reconstruction. J in anterior cruciate ligament reconstruction:
Strength Cond Res. http://dx.doi.org/10.1519/ Orthop Sports Phys Ther. 2005;35:A75. a meta-analysis of randomized controlled tri-
JSC.0b013e3181d83335 35. Paterno MV, Ford KR, Myer GD, Heyl R, als. Arthroscopy. 26:705-713. http://dx.doi.
22. Myer GD, Brent JL, Ford KR, Hewett TE. A pilot Hewett TE. Limb asymmetries in landing and org/10.1016/j.arthro.2009.12.011
study to determine the effect of trunk and hip jumping 2 years following anterior cruciate 48. Stockbrugger BA, Haennel RG. Validity and reli-
focused neuromuscular training on hip and ligament reconstruction. Clin J Sport Med. ability of a medicine ball explosive power test. J
knee isokinetic strength. Br J Sports Med. 2007;17:258-262. http://dx.doi.org/10.1097/ Strength Cond Res. 2001;15:431-438.
2008;42:614-619. http://dx.doi.org/10.1136/ JSM.0b013e31804c77ea 49. Vanderford ML, Meyers MC, Skelly WA, Stewart
bjsm.2007.046086 36. Paterno MV, Myer GD, Ford KR, Hewett TE. Neu- CC, Hamilton KL. Physiological and sport-
23. Myer GD, Ford KR, Brent JL, Hewett TE. The romuscular training improves single-limb stabil- specific skill response of olympic youth soccer
effects of plyometric vs. dynamic stabilization ity in young female athletes. J Orthop Sports athletes. J Strength Cond Res. 2004;18:334-342.
41-06 Myer.indd 386 5/18/2011 12:47:28 PM

http://dx.doi.org/10.1519/R-11922.1 North Am. 2003;34:107-137. tendon autograft reconstruction on neuro-
50. W ilk KE, Andrews JR. Current concepts in 52. W ilk KE, Romaniello WT, Soscia SM, Arrigo CA, muscular performance. Am J Sports Med.
the treatment of anterior cruciate ligament Andrews JR. The relationship between subjec- 2000;28:336-344.
disruption. J Orthop Sports Phys Ther. tive knee scores, isokinetic testing, and func-
1992;15:279-293. tional testing in the ACL-reconstructed knee. J
@ MORE INFORMATION
51. Wilk KE, Reinold MM, Hooks TR. Recent advanc- Orthop Sports Phys Ther. 1994;20:60-73.
es in the rehabilitation of isolated and combined 53. Wojtys EM, Huston LJ. Longitudinal effects of
anterior cruciate ligament injuries. Orthop Clin anterior cruciate ligament injury and patellar WWW.JOSPT.ORG
PUBLISH Your Manuscript in a Journal With International Reach

JOSPT offers authors of accepted papers an international audience. The
Journal is currently distributed to the members of the following
organizations as a member benefit:
• APTA's Orthopaedic and Sports Physical Therapy Sections

• Sports Physiotherapy Australia (SPA) Titled Members
• Physio Austria (PA) Sports Group

• Belgische Vereniging van Manueel Therapeuten-Association Belge des
Thérapeutes Manuels (BVMT-ABTM)
• Comitê de Fisioterapia Esportiva do Estado do Rio de Janeiro
(COFEERJ)
• Canadian Physiotherapy Association (CPA) Orthopaedic Division
• Sociedad Chilena de Kinesiologia del Deporte (SOKIDE)
• Suomen Ortopedisen Manuaalisen Terapian Yhdistys ry (SOMTY)
• German Federal Association of Manual Therapists (DFAMT)
• Hellenic Scientific Society of Physiotherapy (HSSPT) Sports
Injury Section
• Chartered Physiotherapists in Sports and Exercise Medicine (CPSEM)
and Chartered Physiotherapists in Manipulative Therapy (CPMT)
of the Irish Society of Chartered Physiotherapists (ISCP)
• Israeli Physiotherapy Society (IPTS)
• Gruppo di Terapi Manuale (GTM), a special interest group
of Associazione Italiana Fisioterapisti (AIFI)
• New Zealand Sports and Orthopaedic Physiotherapy Association
• Norwegian Sport Physiotherapy Group of the Norwegian Physiotherapist
Association
• Portuguese Sports Physiotherapy Group (PSPG) of the Portuguese
Association of Physiotherapists
• Orthopaedic Manipulative Physiotherapy Group (OMPTG) of the
South African Society of Physiotherapy (SASP)
• Swiss Sports Physiotherapy Association (SSPA)
• Association of Turkish Sports Physiotherapists (ATSP)
In addition, JOSPT reaches students and faculty, physical therapists and

physicians at more than 1,400 institutions in the United States and around the
world. We invite you to review our Information for and Instructions
to Authors at www.jospt.org and submit your manuscript for peer review at
http://mc.manuscriptcentral.com/jospt.
41-06 Myer.indd 387 6/7/2011 5:18:29 PM

FUNCTIONAL TESTS - Myer, 2011 - Test COMBINE NFL Acl Reconstruction

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

FUNCTIONAL TESTS - Myer, 2011 - Test COMBINE NFL Acl Reconstruction

Uploaded by

Copyright:

Available Formats

[ research report ]

Utilization of Modified NFL Combine

TTSTUDY DESIGN: Case control. of both lower extremities showed no group

to bring 1 or 2 teammates to serve as control tation of this important knee-stabilizing

41-06 Myer.indd 377 5/18/2011 12:47:16 PM

41-06 Myer.indd 378 5/18/2011 12:47:18 PM

researcher instructed participants in participant stood 30.5 cm behind the

41-06 Myer.indd 379 5/18/2011 12:47:19 PM

FIGURE 4. Modified pro shuttle.

The participants informed the investiga-

were electronically timed with SPARQ

41-06 Myer.indd 380 5/18/2011 12:47:21 PM

FIGURE 5. Modified long shuttle.

41-06 Myer.indd 381 5/18/2011 12:47:23 PM

41-06 Myer.indd 382 5/18/2011 12:47:24 PM

Uninvolved/dominant† 469.2 (444.0, 494.3) 485.8 (444.9, 526.6)

41-06 Myer.indd 383 5/18/2011 12:47:25 PM

Crossover hop 97 (94, 101) 92 (89, 95)

41-06 Myer.indd 384 5/18/2011 12:47:27 PM

return to sport.27 nificant residual deficits in indi-

41-06 Myer.indd 385 5/18/2011 12:47:28 PM

41-06 Myer.indd 386 5/18/2011 12:47:28 PM

PUBLISH Your Manuscript in a Journal With International Reach

• APTA's Orthopaedic and Sports Physical Therapy Sections

• Physio Austria (PA) Sports Group

In addition, JOSPT reaches students and faculty, physical therapists and

41-06 Myer.indd 387 6/7/2011 5:18:29 PM

You might also like